By Dr. Mercola
Up to 85 percent of menstruating women use tampons, but very little research has been done to confirm, or refute, their safety. What could be dangerous about a tampon?
As noted by Alexandra Scranton, Women's Voices for the Earth (WVE) director of science and research, tampons "are not just your average cosmetics because they are used on an exceptionally sensitive and absorbent part of a woman's body."1
Unfortunately, most tampons are far from pure, and when the chemicals come in contact with your skin, they are absorbed straight into your bloodstream without filtering of any kind, going directly to your organs.
Tampon use is potentially even more problematic than a chemical coming in contact with your external skin, as they are used internally, dramatically increasing the absorption of toxic chemicals.
Plus, tampons are left in place for hours at a time, for several days each month, adding quite a bit of cumulative exposure time. This is why, when creating my line of premium feminine hygiene products, my team sourced only 100% hypoallergenic organic cotton for tampons, and covered them with a special cotton safety layer to help prevent fibers from remaining inside your body.
If you use other feminine care products as well – feminine wipes, washes, douche, or deodorant, for instance – be aware that your level of chemical exposure rises even more.
Back to Biology: Why Vaginal Chemical Exposure May Harm Your Health
Vulvar and vaginal tissues are more permeable than the rest of your skin, making them especially vulnerable to chemicals and other irritants. With mucous membranes, numerous blood vessels, and lymphatic vessels, the vagina provides a direct entryway for chemicals to circulate through the rest of your body. As reported by Scranton:2
"In fact, there is considerable interest in vaginal drug delivery systems because the vagina is such an effective site to transfer drugs directly into the blood without being metabolized first."
Research has shown that not only are chemicals rapidly absorbed and circulated through the rest of your body via your vagina, but some chemicals, like hormone-mimicking substances, may lead to "higher than expected exposures" in the rest of your body.
For instance, a vaginally applied dose of estradiol resulted in systemic estradiol levels 10 to 80 times higher than resulted from the same dose taken orally.3 Another area of concern surrounds cancer-causing chemicals, of which little research has been done regarding their direct exposure to the vagina.
Tampons Classified as Cosmetic and Require NO Safety Testing
Scranton is the author of "Chem Fatale," a report on the potential health effects of toxic chemicals in feminine care products.4 You should know that feminine care products are classified as "cosmetics" as far as the US Food and Drug Administration (FDA) is concerned, and that means no specific tests are required to demonstrate their safety.
Instead, the products' manufacturers are responsible for ensuring the safety of their own products, which means you are really at the mercy of the product makers when purchasing items like feminine wipes or douches.
The exceptions are tampons and pads, which are regulated by the FDA as medical devices. Unfortunately, medical devices are not required to disclose ingredients to consumers, which is why it's very difficult to determine what's actually in a typical tampon.
Most tampons are made from cotton, rayon, or another pulp fiber, but these materials may contain toxic disinfection byproducts from the chlorine bleaching process, including dioxins and furans, as well as pesticides from non-organic cotton.
Studies show that dioxin collects in your fatty tissues, and according to a draft report by the US Environmental Protection Agency (EPA), dioxin is a serious public health threat that has no "safe" level of exposure! Published reports show that even low or trace levels of dioxins may be linked to:
- Abnormal tissue growth in the abdomen and reproductive organs
- Abnormal cell growth throughout the body
- Immune system suppression
- Hormonal and endocrine system disruption
The FDA has stated that while bleaching of wood pulp was at one time a potential source of dioxin in tampons, chlorine-free methods are now used for bleaching and purifying the wood pulp used in many tampons. The Agency's official stance is that there are no expected health risks associated with trace amounts of dioxins in tampons:5
"State-of-the art testing of tampons and tampon materials that can detect even trace amounts of dioxin has shown that dioxin levels are at or below the detectable limit. No risk to health would be expected from these trace amounts."
Dioxins, Pesticides, and Fragrance Chemicals Detected in Tampons
The FDA recommends that tampons be free of dioxin, including TCDD and TCDF, as well as pesticide and herbicide residues. But this is simply a recommendation, not a requirement. As the "Chem Fatale" report revealed, testing has shown that toxic chemicals do exist in tampons, despite the FDA's recommendations:
- A 2002 study found small but detectable levels of TCDF in all four brands of tampons tested6
- A 2013 study detected pesticide residues in o.b. tampons (the only brand tested); the levels were low (some as low as 1 part per million),7 but still show that some exposure is occurring (and many pesticides are considered possible carcinogens and endocrine disruptors)
If you're using scented tampons, be aware that such products may contain any of the nearly 3,000 fragrance chemicals in use, and even unscented tampons may contain far more chemicals than even dioxins and pesticides. A recent analysis by WVE, which acquired public patent documents held by Proctor & Gamble (the maker of Tampax and Always), showed the following chemicals may be in your tampons:8
Creped cellulose wadding Meltblown polymers Chemically-stiffened fibers, polyester fibers, peat moss, and foam Tissue wraps and laminates Super absorbent gels and open-celled foams Myreth-3-myristate (as lubricant) (US Patent # 5,591,123) Natural and synthetic zeolites (as odor-absorbing particles) (US Patent # 5,161,686) Alcohol ethoxylates Glycerol esters, polysorbate-20 (as surfactants to disperse fragrance) Unnamed anti-bacterial agents (US Patent # 8,585,668) Cancer-causing chemicals such as: styrene, pyridine, methyleugenol, and butylated hydroxyanisole (scented products) Phthalates of concern (DEP and DINP) (scented products) Synthetic musks (potential hormone disruptors) (scented products) Numerous allergens (scented products)
Potential Health Hazards of Feminine Care Products Revealed
Tampons and pads are the most-used type of feminine care products, but significant numbers of women also use feminine wipes, washes, douches, sprays, and more (about 10 percent to 40 percent of women use these latter products, although rates rise significantly among African-American and Latina women).9 It's important to understand that the vagina is typically "self-cleaning," and use of douches is not recommended by the American Public Health Association or the American College of Obstetricians and Gynecologists (the latter of which also recommends against fragranced tampons and pads and feminine sprays and powders).10
In fact, the use of douches is associated with increased bacterial infections. Furthermore, as mentioned, these products are often impure and as such may represent an ongoing source of exposure to chemical contaminants. "Chem Fatale" revealed the following potential health hazards from the chemicals that may exist in your feminine care products:11
Hazardous ingredients may include dioxins and furans (from the chlorine bleaching process), pesticide residues, and unknown fragrance chemicals. Exposure concerns include cancer, reproductive harm, endocrine disruption, and allergic rash.
Hazardous ingredients may include dioxins and furans, pesticide residues, unknown fragrance chemicals, and adhesive chemicals such as methyldibromo glutaronitrile. Exposure concerns include cancer, reproductive harm, and endocrine disruption. Studies link pad use to allergic rash.
Hazardous ingredients may include methylchloroisothiazolinone, methylisothiazolinone, parabens, quaternium 15, dmdm Hydantoin, and unknown fragrance chemicals. Exposure concerns include cancer and endocrine disruption. Studies link wipe use to allergic rash.
Hazardous ingredients may include unknown fragrance chemicals, parabens, methylchloroisothiazolinone, methylisothiazolinone, dmdm Hydantoin, d&c red no.33, ext d&c violet #2, and fd&c yellow #5. Exposure concerns include endocrine disruption, allergic rash, and asthma.
Hazardous ingredients may include unknown fragrance chemicals and the spermicide octoxynol-9. Studies link douche use to bacterial vaginosis, pelvic inflammatory disease, cervical cancer, low-birth weight, preterm birth, HIV transmission, sexually transmitted diseases, ectopic pregnancy, chronic yeast infections, and infertility.
Feminine deodorant (sprays, powders, and suppositories)
Hazardous ingredients may include unknown fragrance chemicals, parabens, and benzethonium chloride. Exposure concerns include reproductive harm, endocrine disruption, and allergic rash.
Feminine anti-itch creams
Hazardous ingredients may include unknown fragrance chemicals, parabens, methylisothiazolinone, and an active ingredient, benzocaine, a mild anesthetic. Exposure concerns include endocrine disruption, allergic rash, and unresolved itch.
Tampon Use and Toxic Shock Syndrome (TSS)
Tampons can create a favorable environment for bacteria growth. Micro tears in your vaginal wall from tampons may allow bacteria to enter and accumulate. One recognized risk from tampon use is Toxic Shock Syndrome (TSS), which may be caused by poisonous toxins from either Staphylococcus aureus (staph) or group A streptococcus (strep) bacteria. TSS can be a life-threatening condition, so it's important to recognize the signs and symptoms. Should any of the following symptoms arise while using tampons during your period, make sure you seek medical help:
Sudden high fever Vomiting Diarrhea Low blood pressure Seizures Rash on palms or soles of feet Muscle aches Redness of your eyes, mouth, and/or throat
To minimize your risk of this potentially life-threatening condition:
Avoid super absorbent tampons – choose the lowest absorbency rate to handle your flow Never leave a tampon inserted overnight; use overnight pads instead When inserting a tampon, be extremely careful not to scratch your vaginal lining (avoid plastic applicators) Alternate the use of tampons with sanitary napkins or mini-pads during your period Change tampons at least every 4-6 hours Do not use a tampon between periods
Safer Alternatives for Feminine Care
Many of today's feminine hygiene products are made primarily from rayon, viscose, and cellulose wood fluff pulp… not cotton — let alone organic cotton. Rayon and viscose present a potential danger in part because of their highly absorbent fibers. When used in tampons, these fibers can stick to your vaginal wall, and when you remove the tampon, the loosened fibers stay behind inside your body, thereby raising your risk of TSS. However, to be clear, the FDA notes that tampons made with rayon do not appear to have a higher risk of TSS than cotton tampons of similar absorbency.12 It is the absorbency level that appears to have the greatest association, with higher absorbency products linked to increased TSS risk.
Fortunately, there are safer alternatives. According to Dr. Philip Tierno, a Clinical Professor of Microbiology and Pathology at NYU Medical Centre, 100 percent cotton tampons "consistently test under detectable levels for TSS toxins."
This is just one reason why my line of feminine hygiene products is made with only certified organic or natural cotton – more naturally breathable fiber that may be healthier for your body and the earth. Not only are there NO synthetic fibers in the Mercola line of personal products, but every tampon and pad also contains a special "security veil." This veil, a soft, breathable cotton cover, provides double insurance against any part of the cotton separating from the tampon or pad. My Premium Personal Care line, including organic tampons, natural cotton panty liners, and sanitary pads are also:
- Chlorine- and toxin-free – Keep potentially dangerous substances away from your most intimate body parts.
- Synthetic-free – For a softer and plastic-less feel.
- Wood fluff pulp-free – Breathable, absorbent and saves trees, too.
- Hypoallergenic and soothing, especially for those with sensitive skin.
- User-friendly – Easy and comfortable to use.
Finally, if you want to get involved, to push for full disclosure labeling, Naturally Savvy has created a petition asking Procter & Gamble to disclose the ingredients in their feminine hygiene products. You can sign their petition here.
In addition, it would be wise to minimize, or eliminate, your use of other unnecessary feminine care products, including douches, deodorants, sprays, and wipes. If you are struggling with vaginal dryness or odor, a knowledgeable natural health care practitioner can help you get to the bottom of the underlying problem. You can also find natural solutions for a common vaginal condition, yeast infections, here.